Procedures

Mastectomy Teaching 1850

Patient with bilateral mastectomy with strips with moderate serosanguineous drainage, and two Jackson-pratt skilled nurse performed JP Drain Care , the JP drain removes fluids by creating suction in the tube. JP#1 drain 30 ml and JP#2 drain 25 Ml serosanguineous drainage .The bulb is squeezed flat and connected to the tube that sticks out of your body. The bulb expands as it fills with fluid.

Tracheostomy Teaching 1851

Instructed patient sterile technique includes: Hand washing, Wearing sterile gloves. Using a new trach tube, inner cannula, and trach tie. Using sterile water (new bottle or bag every 24 hours). Discarding suction catheters after each use.

Tracheostomy Teaching 1852

Instructed patient Clean technique includes: Hand washing, Using gloves is optional. Re-using a trach tube and/or inner cannula that has been properly cleaned, Using prepared sterile water and normal saline. Re-using the same trach ties if they are properly cleaned. Re-using suction catheters if they are properly cleaned(up to 8 hrs or 3/per day)

Tracheostomy Teaching 1853

Instructed patient as much as possible, the skin should be kept clean and dry. You may need to clean the skin around the trach tube several times throughout the day. Call your doctor if you notice thick secretions that are yellow or green in color.

Tracheostomy Teaching 1859

Instructed patient the following is a list of preventive measures that may help to avoid some problems: Make sure the trach is getting enough humidity. Humidity will keep the mucus loose and decrease the chances of a mucus plug. If you hear a whistling sound from the trach, this might mean that the airway is dry. Always make sure the trach ties are securely fastened and are tight enough around the neck.

Tracheostomy Teaching 1862

Instructed patient what to do if a person has trouble breathing The most common reason for breathing problems, other than an illness, is If you have trouble passing the catheter into the trach and it feels tight, put a few drops of saline into the tube and try to suction again. Do not force the catheter; it may push the plug in further. If you are unable to remove the mucus plug, change the trach tube and try to suction again.

Dialysis care Teaching 2119

SN instructed patient that fluid restrictions are usually necessary when dialysis is initiated, especially if dialysis only occurs three days a week and if urine production is decreased. Build up of fluid can lead to shortness of breath, swelling, and high blood pressure. There is a limit to the amount of fluid that can be safely removed during dialysis. If fluid limits are exceeded and extra water must be removed, negative effects such as muscle cramping, low blood pressure leading to nausea, weakness, dizziness, and possibly extra dialysis sessions to remove the fluid.

Chemotherapy Teaching 2122

Physical assessment done to patient after chemotherapy . Medication checked and reconciled. Hydration and nutritional status checked. Diet reviewed. Denies chest pain. Tube care done per physician ( MD ) order. Dressing changed. Still complained in pain in fingers, patient taught that one side effect of chemotherapy is pain in fingers which is called peripheral neuropathy, it results from some type of damage to the peripheral nerves. Certain chemotherapy drugs can cause peripheral neuropathy such as Vinca alkaloids ( vincristine ), cisplatin, Paclitaxel, and the podophyllotoxins ( etoposide and tenoposide) . Other drugs used to treat cancer such as thalidomide and interferon also can cause peripheral neuropathy.

Colostomy Teaching 1868

Instructed patient in some cases of colostomy, skin irritation or infection can result from stool that leaks under the bag. A hernia can develop around a colostomy, and the bowel may become narrow. Taking good care of your stoma and eating a balanced diet can help you avoid these problems. Pouching systems are waterproof. However, you may feel more secure if you wear an ostomy belt or put 
tape around the edges of your skin barrier when you are in the water.

Colostomy Teaching 1869

Instructed patient If you do put tape around the skin barrier edges do not remove the tape after water activities. Removing the
 tape may cause the skin barrier to loosen. It is helpful to hold your skin smooth as you put your pouching system on to avoid wrinkles that may lead to leakage.